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Excel in Health: Understanding the NHS

  1. Excel in Health Understanding the NHS
  2. 1. Understanding the NHS 2. Relevant knowledge and skills for success 3. Applying your learning and pitching your innovation Three day programme overview: @innovationnwc
  3. Find someone you’ve never met: Spend TWO MINUTES (each) sharing: What challenges do you bring with you today? What are you hoping to get from this experience? Repeat with another new contact… @innovationnwc
  4. Today’s outcomes By the end of our session today, you will be able to: Identify characteristics of NHS structure and system Recognise processes for working with the procurement system Identify relevant elements of NHS culture that may impact your work Respond to Reflection #1 in your workbook @innovationnwc
  5. NHS landscape
  6. NHS landscape: topics NHS history overview NHS structures National context STP/ICS priorities @innovationnwc
  7. NHS history and context • Created in 1948 • Free at point of care to all • £125B = 7% of GDP • 1M patients every 36 hours • 1.2 million staff • 135 acute non-specialist trusts • 17 acute specialist trusts • 54 mental health trusts • 35 community providers @innovationnwc
  8. NHS core principles 1. Meeting the needs of everyone 2. Free at the point of delivery 3. Based on clinical need, not ability to pay @innovationnwc
  9. NHS structure @innovationnwc
  10. @innovationnwc
  11. • Clinical commissioning groups (CCGs) replaced primary care trusts (PCTs) 2013. • CCGs can commission any service provider - NHS trust, social enterprises, charities or private sector providers. • 220 CCGs grouped into 44 STPs @innovationnwc
  12. • NHS England/NHS Improvement – single entity regional teams • 1948 - £437M (£15 billion at today’s value) • 2017/18 - £125B • Budget increase by 1.2% between 09/10 and 20/21 • Cost increase of 4%, cash reduction, activity rising at 4% annum • L/T average of 4% £ increase not keeping pace with demand @innovationnwc
  13. National health and care challenges 30% of people in Liverpool live with one or more long term conditions The difference in life expectancy between areas across LCR can vary by more than 10 years By 2021 there will be 9% (5700) MORE people living beyond 65 years with the biggest growth in those aged 70-75 and 85+ Over half of adults are overweight or obese @innovationnwc
  14. • Shift the emphasis from disease and distress to prevention and promotion (prevent the fires) • Passive patient becomes more discerning and responsible for their health and wellbeing – choices and consequences • Technology • Resource optimisation • Reducing duplication • Greater standardisation and reliability @innovationnwc
  15. The Accelerated Access Review “Seventeen years ago, I performed the first operation in the UK using a surgical robot. As it happens, that is the average time it takes for an innovation to spread around the NHS” “But 17 years? It is far too slow. That is why the joint government-industry group, the Accelerated Access Collaborative was launched to identify the most transformative medical innovations and ensure they are available on the NHS up to four years earlier than at present” Professor the Lord Darzi of Denham Chair of the Accelerated Access Collaborative & Chair of surgery at Imperial College @innovationnwc
  16. Clinical priorities • Early diagnosis • Measures enabling rapid diagnosisCancer • Prevention • FH; Cardiac Arrest; Stroke servicesCVD • Prevention • Monitors; self care; choices and consequencesDiabetes • Prevention • Rehab; Meds Opimisation; Risk ScoringRespiratory • Children and young people (25% prevalence) • Crisis; suicide preventionMental Health @innovationnwc
  17. Service delivery priorities • Primary Care Networks • To integrate teams and digital servicesPrimary Care • Urgent treatment centres, NHS 111 • To reduce pressure on A&EUrgent Care • Digital transformation • To reduce wait times and delayed transfersAcute Care • IAPT expansion • Crisis; suicide preventionMental Health @innovationnwc
  18. • 60% of Trusts are in the red • We pay for activity not outcomes • Annual budgetsFinance • More patients, less staff • 100k workforce gap • Retention and skill developmentWorkforce • Digitalising the system for patients and clinicians • Interoperability of digital systems • Patient information and record sharingDigital Resource challenges @innovationnwc
  19. Integrated Care System Currently a shadow integrated care system called Healthier Lancashire and South Cumbria: • five integrated care partnerships • 1.7m population • 8 CCGs • 5 Trusts • 4 upper tier Local Authorities • NHS England and NHS Improvement • Wider partners such as voluntary, charity, hospices and education Morecambe Bay Pennine Lancashire Central LancashireWest Lancashire Fylde Coast Lancashire and South Cumbria @innovationnwc
  20. Healthier Lancashire Out of Hospital Acute and Specialised Mental Health Prevention and Population Health • Regulated Care • Primary Care • Stroke • Cancer Alliance • Better Births • Head and neck • Vascular • Diagnostics • Pathology • Children and Young People • Suicide Prevention • Preventing Diabetes • Public Health • Population Health • Personalised care Commissioning Urgent and Emergency Workforce Digital • Commissioning development • Clinical policy reviews • Respiratory • Falls • UTIs Careers Clinician Passport It's Your Move Well at Work Our digital future @innovationnwc
  21. Cheshire and Merseyside Healthcare Partnership • 12 CCGs • 9 Local Authorities • 20 Provider Trusts Focussed on: • Collaboration and partnership • Joined up care • Targeting localised priorities • Implementing a place based care matrix @innovationnwc
  22. Cheshire and Merseyside Healthcare Partnership Health Inequalities Focus • Mental wellbeing • Zero suicide • Cardiovascular disease – zero strokes • No harm from alcohol • Every child immunised • Reducing falls • No violent crime @innovationnwc
  23. Where does your innovation match system needs? Respond to Reflection #2 in your workbook @innovationnwc
  24. Procurement and Commissioning
  25. • Where is the funding? • Procurement towers • Procurement frameworks • Other avenues… • Hot topics Procurement: our topics @innovationnwc
  26. Procurement: landscape @innovationnwc
  27. Commissioning and regulation
  28. @innovationnwc
  29. NHS England GP practice GMS / PMS contract Local authority Social care Domiciliary care Care homes Other providers CCG NHS Acute Trust NHS Mental Health Trust NHS Community Trust Payment by results Block contracts Contracts for services Self funders @innovationnwc
  30. What does this mean for you? • Providers procure products, Commissioners commission services • STPs may have some funds. Integrated Care Systems aren’t real world (yet!) • The org that uses a product may not be the organisation that reaps the benefit • Operational efficiencies vs cost savings • 70% NHS costs are in staff. Incremental changes are not cash releasing for commissioners. • What will your product replace or improve? • The tariff for PbR is available publically. Use it. @innovationnwc
  31. • More with less • Reduce variation • Increase efficiency • Reduce cost without clinical compromise Repeat…. Procurement seen as key solution to these problems @innovationnwc
  32. DH – Leading the nation’s health and care Procurement towers A Category Tower is a public or private sector organisation that is responsible for the sourcing of a pre-determined specific logical group of products on behalf of the NHS. Non Medical Tower 11 NHS Hotel Services Tower 4 Orthopaedics, Trauma & Spine, Ophthalmology Medical Tower 3 Infection Control And Wound Care Tower 5 Rehabilitation, Disable Services, Women’s Health & Associated Consumables Tower 2 Sterile Intervention Equipment And Associated Consumables Tower 10 Food Tower 9 Office Environment Capital Tower 7 Large Diagnostic Capital Devices incl. Mobile & Consumables Tower 8 Diagnostic Equipment and Associated Consumables Tower 1 Ward Based Consumables Tower 6 Cardio-Vascular, Radiology, Audiology & Pain Management @innovationnwc
  33. @innovationnwc
  34. • Register on the NHSSC supplier portal • Consider partnering with a larger supplier • Consider forming a consortia • Use your AHSN as conduit @innovationnwc
  35. Health systems support framework • About the framework • Scope of Framework Lots 1 – 10 • Who can use the framework • Lot 0 NHSE to create ‘innovation greenhouse’ to accelerate uptake of technology • G-Cloud 11 - CCS You can compete!
  36. What is a framework agreement? Definition: an agreement between a Contracting Authority (e.g. NHS SBS, an NHS Trust, or a local council) and one or more suppliers, the purpose of which is to establish the terms governing contracts to be awarded during a given period, in particular with regard to price and, where appropriate, the quantity. • 6-9 month procurement process • Awarded following a fully OJEU compliant process under the 2015 Public Contracts Regulations • Usually awarded for a period of 4 years • *Legal requirement for public sector procurements over the value of £118K • Approx. cost of £25,000 per tender process for a Contracting Authority @innovationnwc
  37. Healthcare Contrast Media Cardiology, interventional radiology and vascular grafts Ophthalmolog y Equipment and consumable Respiratory therapy Insourcing Orthopaedic Products including power tools, arthroscopy products and long bone healing Clinical Managed Services Community Equipment Products and Services Orthotics and Prosthetics Products and Services Medical Imaging and Radiotherapy Advanced Woundcare / Advanced Woundcare Delivery Patient Connected Support and Therapy Equipment Point of Care Testing: Drugs of Abuse @innovationnwc
  38. Opportunities - if no…what alternatives? • AHSN’s links in to Procurement Teams • Support with Insight, Apsiz • Countess of Chester Hospital work with Leanvation
  39. Making NHS SBS procurement easy AI Enabled Framework Agreement Portal • Phase 1 – customers can search, find and sign up to agreements on-line • Phase 2 – customers can navigate category detail and create bespoke contracts online Increased Implementation Support Resource • Supporting customers in navigating and using our Framework Agreements Customer Engagement – Geographical Expansion of Team • Creating a national engagement strategy • Growth of the Commercial and Clinical Engagement Team in 2018 /19 to cover NHS @innovationnwc
  40. Trust procurement policy – an NHS example @innovationnwc
  41. Definition: a contract that is awarded to a Framework supplier without further competition. 1. The supplier must already be awarded to the Lot relevant to the work being procured. 2. Make initial contact with the preferred supplier through the Capability Assessment or; 3. Contact the preferred supplier directly via the details provided within the Buying Guide whilst quoting the Framework reference number. 4. Notify the supplier of the requirements, time frames and scope of the work. 5. Agree upon a contracted rate – where possible this should relate back to the indicative Framework rates provided. 6. Place the order directly with the chosen supplier using framework reference number 7. Where appropriate, Sign SLA with the supplier and return to NHS SBS to complete the process. Direct Award @innovationnwc
  42. Where to look for NHS Opportunities NHS Opportunities MUST be published online - you need to put the work in, you have to search! Essential Sites: Above OJEU >£118k DoH, NHS Trusts / £181k NHS England, CCGs & NHS Foundation Trusts • TED Europa Below OJEU >£10k to £118k / £181k • Contracts Finder Contracts Finder pulls from all sites where possible (One Place – Full Transparency) Other Useful Sites: • Public Contracts Scotland – • Sell2Wales – • eSourcing Northern Ireland – @innovationnwc
  43. How to look for NHS opportunities • Registering is essential • Register for all or as many as possible • Searching for Opportunities is critical • CPV Codes, NUTS codes and / or Key Words • CPV Codes – define what is being sourced (e.g. 3314000 Medical Consumables) • NUTS codes define the location (e.g. Essex – UKH3) • Use Alerts • Regularly review sites and evaluate opportunities @innovationnwc
  44. Procurement Hot Topics @innovationnwc
  45. Why is it hot? • Restructure of NHS Supply Chain • NHS Procurement Target Operating Model tender – Deloittes work is underway Impact • Uncertainty at all levels – local, regional, national • Costs increasing in some cases as long term deals cannot be secured • Targets increasing for Procurement teams at Trusts as the top slicing starts to impact • More scrutiny on structures and landscape • Procurement resource getting more difficult to attract and retain, salaries being pushed. Great for the profession, not so great for the discussion with HR! Hot topic 1: the changing NHS procurement landscape @innovationnwc
  46. Why? • Uncertainty – D1ND • High profile Impact • Pressure on Procurement teams to understand and measure the risk • DH central co-ordination • Stock piling • Increasing supply chain issues emerging i.e. cold storage • Prices increasing • Post Brexit Law: Government publishes draft Public Procurement Regulations Amendment for EU Exit which will be of relevance to all public sector bodies and potential suppliers in the UK. Hot topic 2: Brexit @innovationnwc
  47. Why? • Limited Capital Fund for equipment replacement • Increased demand in some health areas e.g. endoscopy • VAT Recovery opportunities • Growth in digital/tech services and markets • Development and growth of innovative solutions in response to NHS challenges • Shift from product to service based contracts Impact • Growth in demand for Clinical Managed Equipment Services • Increase in complex and innovative commercial models that are scalable • Suppliers getting innovative with commercial models e.g. driving outcome based solutions • Category expertise is often limited in these areas • NHS Standard Terms and Conditions are not always appropriate Hot topic 3: changing NHS spend profile @innovationnwc
  48. @innovationnwc
  49. Understanding NHS culture
  50. Culture describes the rich pattern of social behaviour present in an organisation over time, including all spoken and unspoken rules, symbols, routines and stories. Culture binds together an organisation’s different parts, giving identity to the whole.’ This includes: • Values • Assumptions • Artefacts
  51. @innovationnwc
  52. Old power values New power values Formal (representative) governance, managerialism, institutionalism Informal (networked) governance, opt-in decision-making, self- organisation Competition, exclusivity, resource consolidation Collaboration, crowd wisdom, sharing, open-sourcing Confidentiality, discretion, separation between private and public spheres Radical transparency Expertise, professionalism, specialisation Maker-culture, “do it ourselves” ethic Long-term affiliation and loyalty, less overall participation Short-terms conditional affiliation, more overall participation @innovationnwc
  53. • Learning culture • Listening culture • Open and transparent culture • Just culture
  54. • Vision and values • Goals and performance • Support and compassion • Learning and innovation • Teamwork @innovationnwc
  55. Value The way we do things Constant commitment to quality of care Everyone taking responsibility in their work for living a shared vision and embodying shared values @innovationnwc
  56. Value The way we do things Effective, efficient, high quality performance Everyone ensuring that there are clear priorities and objectives at every level and intelligent data constantly informing all about performance. @innovationnwc
  57. Value The way we do things Support, compassion, and inclusion for all patients and staff Everyone making sure all interactions involve careful attention, empathy, and intent to take intelligent helping action. @innovationnwc
  58. Value The way we do things Continuous learning, quality improvement, and innovation Everyone taking responsibility for improving quality, learning, and developing better ways of doing things. @innovationnwc
  59. Value The way we do things Enthusiastic cooperation, team working, and support within and across organisations Everyone taking responsibility for effective team-based working, interconnectedness with and across organisations, systems thinking and acting. @innovationnwc
  60. Vision and Values Goals and Performance Support and Compassion Learning and Innovation Teamwork
  61. Resistance to change Shock Frustration Resistance Exploration Commitment Integration Valley of Despair @innovationnwc
  62. Overcoming fixed mindsets @innovationnwc
  63. Respond to Reflection #3 in your workbook @innovationnwc
  64. Excel in Health Understanding the NHS